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Women recovering from hysterectomy should take caution not to engage in too much physical activity or engage in sexual relations until their cuff has completely recovered, otherwise it could tear and lead to further complications.
This article presents two cases of vaginal cuff dehiscence and evisceration after hysterectomy (VCDE), which has various radiologic features on CT such as mural discontinuity in the vaginal cuff, herniation of omental fat into vaginal canal, pelvic hematochezia, bowel obstruction and pneumoperitoneum.
Vaginal cuff dehiscence can appear any time after having their uterus removed, sometimes years after. It is most prevalent among women who undergo total laparoscopic or robotic hysterectomy and is most often related to the type of suturing used during surgery; postmenopausal women are particularly prone to this complication; other risk factors include smoking cigarettes and endometriosis/polycystic ovary syndrome as well as type of hysterectomy procedure used.
Symptoms of a Vaginal Cuff Tear
Vaginal cuff tear, or vaginal cuff dehiscence, is a rare complication post hysterectomy. Laparoscopic or robotic procedures pose higher risk than abdominal or vaginal surgeries.
Symptoms include sudden severe abdominal/pelvic pain, vaginal bleeding/discharge, pelvic pressure, fluid influx, and foul vaginal smell. Symptoms can manifest within days post-surgery or later. If experienced, seek immediate medical attention. Vaginal cuff dehiscence requires urgent surgery, especially if bowel evisceration occurs, where bowels push through the tear.
Abdominal Pain
Pain in the belly is a common experience and usually nothing to worry about, though certain causes require medical intervention.
When suffering from vaginal cuff tears, abdominal pain can be severe and usually sharp. This pain could arise as either a single or repeated event and usually manifests itself either in the middle or lower abdomen and often prompts actions such as sexual activity, bowel movements or coughing.
Rare complications of hysterectomy arise when an incision used to create the vaginal cuff tears open and dehiscence occurs, with edges of wound separate, leading to possible bowel evisceration.
When this occurs it should be reviewed thoroughly along with surgical consultation as pain of gradual onset is associated with various intraabdominal conditions and makes accurate diagnosis more challenging than sudden/rapid pain onset; additionally referred pain from irritation of phrenic, genitofemoral, or ileocecal nerves further complicate this diagnosis process.
Urinary Tract Infections
Urinary tract infections (UTIs), more commonly referred to as UTIs, occur when bacteria infiltrate the kidneys, bladder or urethra. While many UTIs respond quickly to antibiotic treatment, untreated urinary tract infections can become serious issues like sepsis.
An urinary tract infection may cause pain, fever, chills, disorientation and back or side discomfort. If these are present for you it’s important to contact a healthcare provider immediately as this infection could worsen quickly.
Vaginal cuff dehiscence is an uncommon but serious postoperative complication of hysterectomy that can occur any time post-uterus removal, from immediate to years later. It is more prevalent among women who undergo robotic or laparoscopic hysterectomies as opposed to abdominal ones.
Bowel Evisceration
Rare yet serious complications associated with vaginal cuff tears include bowel evisceration.
This occurs when an incision used to make the cuff tears open and part of the bowel pushes its way out through an abdominal wound into the vaginal cavity, creating an emergency situation which must be managed quickly in an emergency department setting.
Patients should be given fluid and broad-spectrum antibiotics immediately. Bowel moisture must also be preserved by using sterile dressing. Should there be no signs of hematoma or abscesses present, brief attempts should be made at manually replacing it if possible and patients tolerate it well.
Patients who have recently undergone hysterectomy should raise concerns of cuff dehiscence if they experience pain, pressure or changes to bowel habits after their surgery.
A thorough history and exam must be taken in order to rule out the possibility of bowel evisceration – an extremely rare complication which could potentially result in intestinal strangulation quickly if it involves distal ileum rupture and lead to intestinal strangulation.
What Causes Vaginal Cuff Tears
Vaginal cuff tears, or vaginal cuff dehiscence, are rare complications after hysterectomy. While the exact cause is unknown, several risk factors increase its likelihood. Women who undergo laparoscopic or robotic hysterectomy face higher risk than those with abdominal or vaginal procedures.
Additional risk factors include vaginal atrophy, hematoma, pelvic radiation history, smoking, pelvic infections, immunosuppressant therapy, chronic pressure conditions (e.g., coughing, obesity, constipation). Tears can occur spontaneously or due to sexual activity or bowel movements.
If you experience symptoms like severe abdominal/pelvic pain, vaginal discharge/bleeding, pelvic pressure, or foul odor, seek immediate medical attention. Vaginal cuff dehiscence is a surgical emergency, warranting immediate repair. Bowel evisceration, where bowels push through the tear, can also occur.
What Are the Treatment Options for Vaginal Cuff Tears
Vaginal cuff tears, or vaginal cuff dehiscence, are rare yet serious complications of hysterectomy.
If you encounter symptoms of vaginal cuff tear—sudden or severe abdominal/pelvic pain, vaginal discharge/bleeding, vaginal pressure, lower pelvic region discomfort, vaginal fluid influx, or a foul vaginal odor—immediate medical attention is crucial.
Vaginal cuff dehiscence mandates swift surgical intervention; patients should be promptly taken to the operating room for repair. Treatment choices encompass surgical repair, either transvaginally or laparoscopically, determined by tear severity.
At times, an omental flap may enhance tissue healing. Effective strategies to reduce dehiscence risk involve the use of barbed sutures and a laparoscopic approach to close the vaginal cuff. Recovery from vaginal cuff repair necessitates a minimum of 6-8 weeks, possibly longer, contingent upon overall health.
